Psychiatry Flashcards
(90 cards)
1
Q
Psych
Describe what trichotillomania disease is.
A
A disorder characterized by an irresistible urge to pull one’s own hair.
2
Q
What are the symptoms of trichotillomania?
A
- Hairl loss;
- Varied hair lenght;
- Presence of broken hairs;
- Absence of scalp scarring;
- Tension before pulling the hair with relief after pulling it;
- Anxiety, stress, emotional distress.
3
Q
What is the management of trichotillomania?
A
Habit reversal training.
4
Q
What are the risk factors for suicide?
A
-
Previous suicide attempts and self-harm; -
Divorce; - Male gender;
- Unemployment;
- Depression / mental illness;
- Alcohol and drug abuse.
5
Q
What are the risk factors for COMPLETED suicide?
A
Efforts to avoid discovery;- Leaving a suicide note;
- Violent methods.
6
Q
What are the protective factors for suicide?
A
- Strong faith;
- Marriage;
- Having children.
7
Q
What are the features of social anxiety behaviour?
A
Avoiding situations such as:
- Meeting / giving presentations;
- Meeting people (strangers);
- Speaking to an authority figure;
- Group events;
- Being observed while eating.
8
Q
What is the management of social anxiety behaviour?
A
- Cognitive behavioural therapy;
- SSRIs.
9
Q
DDx between:
- Social anxiety behaviour
- Panic disorder
A
Social anxiety behaviour
- Patient feels like being judged or rejected.
Panic disorder
- No specific trigger.
10
Q
What are the symptoms
of depression?
A
One of the following:
- Constant low moods;
- Loss of interest/pleasure in most activities.
Plus 3 of the following:
- Fatigue;
- Worthlessness;
- Suicidal thoughts;
- Decreased concentration;
- Insomnia;
- Weight loss.
➜ Symptoms should be there > 2 weeks & affect work/daily activities.
11
Q
What are the management
of depression?
A
1. CBT
2.Antidepressants (SSRI 1st line)
- Fluoxetine;
- Sertaline;
- Citalopram;
3.Electroconvulsive therapy
12
Q
What is Dysthymia?
A
Chronic mild depression for > 2 years.
13
Q
After started taking antidepressants, when should improvements be expected?
A
- Improvements can be expected after
2-4 weeks. - Full effects by
6 weeks; - If there is improvement, meds should be continued for
6 months.
➜ If no improvement by 4 - 6 weeks on the maximum dose, than switch to another antidepressant.
14
Q
Describe the symptoms of atypical depression.
A
- Low mood;
- ⬆︎ appetite;
- Weight gain;
- Hypersomnia, somnolence.
15
Q
What is the Rx of adolescence depression?
A
First line: Psychotherapy;
Second line:
- Fluoxetine (best med for < 18 YO).
16
Q
After starting antidepressants, when should a follow up be scheduled for?
A
Adults: 2-4 weeks
Teens: 2 weeks
17
Q
Which antidepressant is contraindicated on patients with myocardial infarction?
A
Citalopram
- It prolongs the QT interval.
18
Q
Which antidepressant is reccomended on patients with myocardial infarction?
A
- Sertaline
- Mirtazapine (reccomended for coronary patients with risk of GI bleeding due to
warfarin)
19
Q
Which antidepressant can cause weight gain?
A
- Mirtazapine
- Amitriptyline
➜ Avoid in high BMI.
20
Q
What are the indications of electroconvulsive therapy?
A
- Life threatening depression
- High suicide rate
21
Q
Describe gradiose delusions.
A
Belief that one is:
- Famous
- Omnipotent
- Wealthy
- Very powerful
➜ Associated with schizophrenia and bipolar manic state.
22
Q
Describe what is unilateral neglect delusion.
A
Belief that one limb or side does not exist.
23
Q
Describe what is delusion of guilt.
A
“I am responsible for the hurricane/flooding and thus need to be punished.”
24
Q
Describe what is persecutory delusion.
A
“They are spying on me.”
“They are chasing me.”
“They are plotting against me.”
25
# Psych.
Describe what is **Ekbom syndrome**.
"I am infested by parasites."
26
Describe what is `delusion of control`.
"The chef is controlling my behaviour and feelings".
27
Describe what is **delusion of reference**.
"The TV reporter is talking directly to me and giving me a special message that only I would understand."
28
Describe what is **delusional perception**.
"I see the man is wearing a blue scarf today, it must mean that aliens are watching me."
29
# Delusions
Describe what is **folie a deux**.
➜ Shared psychosis.
- Delusional belief/hallucinations are shared between 2 individuals who are in a relationship.
30
# `Delusional of jealousy`
Describe what is **Othello's syndrome**.
Believing a partner is being unfaithful.
31
# Delusion
Describe what is **erotomania**.
Belief that a person of higher social status falls in love with him/her.
32
# Delusions
Describe what are:
- **Capgras syndrome**
- **Fregoli syndrome**
**Capgras syndrome**
- Belief that someone they know (or recognise) has been replaced by an imposter.
**Fregoli syndrome**
- Belief that different people (more than one) are in fact a single person that changes appearance.
33
Describe what is **nihilistic delusion**.
Belief that the person is:
- Already dead;
- Does not exist;
- The world has ended or it's not real.
34
# Delusional seen in schizophrenics
Describe what is **thought insertion**.
Thoughts are being inserted into the patient's head from outside.
35
# Delusional seen in schizophrenics
Describe what is **thought withdrawal**.
Thoughts have been stolen from his/her mind.
36
# Delusional seen in schizophrenics
Describe what is **thought broascasting**.
Thoughts are being acessible directly to others.
37
# Delusional seen in schizophrenics
Describe what is **thought blocking**.
➜ **Sudden break in the chain of thoughts.**
"The patient stops talking for a few seconds followed by speech in a different topic."
38
What are the `features` of **postpartum blues**?
**Symptoms**
- Anxious
- Tearful
- Irritable
- Low moods
- Benign
**Presentation**
- Benign;
- 3 to 7 days after birth;
- Resolves within 1 week;
**Rx**
- Reassurance
39
What are the `features` of **postpartum depression**?
**Symptoms**
- Low moods
- Loss of pleasure
- Anxiety
- Sleep disturbances
- Suicidal thoughts
- `Occasional thoughts of harming baby`
**Presentation**
- 1 month to 1 year after birth;
**Rx**
- CBT
- SSRI's (`sertaline`)
40
What are the `features` of **postpartum psychosis**?
**Symptoms**
- `Thoughts of harming baby`
- Hearing voices saying baby is evil
- Hallucinations
- Delusion
- Suicidal thoughts
**Presentation**
- 2 - 4 days postpartum;
- Peaks at 2 weeks.
**Rx**
- **`EMERGENCY`**;
- Hospital admission;
- Anti-psychotics;
- Antidepressants;
- ECT (electroconvulsive therapy).
41
What is the `antidepressant` reccomended for **breastfeeding mothers**?
Sertaline.
42
Describe what is **generalised anxiety disorder**.
Excessive anxiety and worry for at least **6 months (or several months)**, about a wide range of events or activities.
43
What are the `symptoms` of **generalised anxiety disorder**?
- Palpitations
- Trembling / shacking
- `Constant worrying`
- Sleep disturbances
- Irritability
44
What is the `management` of **generalised anxiety disorder**?
- CBT
- Sertaline
- If innefective offer alternative SSRI or SNRI
45
**DDx between**
- Panic attacks
- Panic disorder
- Generalised anxiety disorder
**Panic attacks**
- Discrete episodes of intense fear with physical symptoms
**Panic disorder**
- Reccurent panic attacks
- No triggers
- Comes out of the blue
**GAD**
- Excesive anxiety and worry
- About a wide range of events/activities
- Min of 6 months
46
DDx between:
- **Somatic symptom disorder**
- **Illness anxiety disorder** *(hypochondriasis)*
**Somatic symptom disorder**
- `1 or more physical symptom`;
- `Chronic course` *(excessive time focused on symptoms leading to distress)*;
- Excessive diagnostic testing;
- Rejection of previous doctors;
`➜ Rx:` psycotherapy with regular visits to the same doctor.
**Illness anxiety disorder** / hypochondriasis
- Constant thinking of acquiring or having a serious illness (despite medical evaluation and reassurance)
- Minimal to no somatical symptoms
`➜ Rx: CBT`
47
Describe the **features** of `Munchausen's syndrome`?
| Facticious disorder imposed on self.
- Intentional falsification of physical or psychological symptoms to obtain medical attention and Rx.
48
Describe the **features** of `Munchausen's syndrome` **`by proxy`**?
Parent or carer produce false illness in a child or adult under their care.
49
Describe the **features** of `conversion disorder`?
➔ **Loss of motor or sensory function:**
`Without organic cause`
- Paralysis
- Blindness
- Mutism
➔ Often triggered by stressor
➔ Patients do not intentionally fabricate their symptoms.
50
Describe the `symptoms` of **lithium toxicity**.
- Coarse tremor;
- Nausea and vomiting;
- Drowsiness;
- Hyperreflexia
- Seizure and coma
## Footnote
`Diuretics` and `NSAIDs` can cause lithium toxicity by ⬆︎ renal reabsorption.
51
What is the `Rx` of **lithium toxicity**?
**Mild to moderate:**
- Stop the drug immediately;
- IV fluids;
**Severe toxicity**
- Haemodialysis.
52
What is the `investigation` done in **lithium toxicity**?
Serum lithium concentration.
53
Describe what is **Ebstein's anomaly**?
A disorder caused by lithium administered during pregnancy.
54
DDx between:
- **Mania**
- **Hypomania**
- **Bipolar disorder**
**Mania**
- High moods
- Psychotic symptoms
- Symptoms impair daily functions
**Hypomania**
- High moods
**Bipolar disorder**
- Period of high moods followed by periods of depressive moods.
55
What are the `symptoms` of **mania**?
➔ **Symptoms ≥ 1 week**
- Elevated mood
- ⬆︎ physical and mental activity;
- Excessive amounts of energy;
- Rapid speech;
- ⬇︎ need for sleep
- Easily distracted
- Impulsivity
- `Delusions` of grandeur
- `Hallucinations`
56
What are the `symptoms` of **hypomania**?
- Milder version of mania;
- No hallucinations or delusions.
57
What are the `Rx` of **mania**?
**1st line**
- Lithium
**Others:**
`➔ Anticonvulsants or mood stabilizers`
- Sodium valproate
- Carbamazepine
`➔ Antipsychotics`
- Olanzapine
- Quetiapine
- Aripiprazole
`➔ Psychoterapy`
58
What are the **features** of `bipolar disorder`?
- `Mania` / `Hypomania` alternating with `depression`;
- High suicide risk.
59
What is the **Rx** for `bipolar disorder`?
- If GP surgery (primary care) ⟶ `refer to psychiatry`;
- If psychiatry clinic or not mentioned ⟶ mood stabilisers (`Lithium`);
60
What is **cyclothymia**?
- Milder form of bipolar disorder;
- Mild depression and hypomania;
- ≥ 2 years.
61
Describe what is **neuroleptic malignant syndrome**.
A life-threatening reaction to anti-dopaminergic / antipsychotic meds.
➔ Onset is within a few weeks of starting the meds (but can happen at anytime).
62
What is the `treatment` of **neuroleptic malignant syndrome**?
- Stop offending medication;
- Rapid cooling;
- Dopaminergic agents: bromocriptine.
63
DDx between:
- **Neuroleptic malignant syndrome**
- **Malignant hyperthermia**
**Neuroleptic malignant syndrome**
- High temperature
- Muscle rigidity
- Sweating
`◆ Cause:` anti-dopaminergic / antipsychotics.
`◆ Onset:` Hours to days.
**Malignant hyperthermia**
- Genetic component
- High temperature
- Muscle rigidity
- Sweating
`◆ Cause:` Suxa / volatile anaesthetics
`◆ Onset:` Minutes to hours.
64
What is the `management` of **obsessive compulsive behaviour**?
**1st line:**
- CBT (exposure and response prevention);
**2nd line:**
- SSRI's
65
What are the `features` of **PTSD**?
**Re-experiencing**
- Flashbacks of the traumatic event;
- Repetitive nightmares;
**Avoidance**
- Avoiding situations and people associated with the traumatic event;
**Hyperarousal**
- Hypervigilance for threat;
- Exaggerated startle response;
- Difficulty sleeping.
66
What is the `Rx` for **PTSD**?
**First line**
- Trauma focused CBT
`In case of failure`
- EMDR: Eye movement desensitisation and reprocessing;
**Second line**
- SSRIs
67
What are the `features` of **schizophrenia**?
`≥ 2 of the following:`
- Delusions;
- Hallucinations (often auditory);
- Disorganised speech;
- Disorganised behaviour;
- Negative symptoms: neglect, social withdrawal, emotional apathy, lack of drive
➜ **Symptoms should be present for at least 1 month for diagnosis.**
68
What is the `Rx` of **schizophrenia**?
◆ Atypical antipsychotics:
- Risperidone
- Olanzapine
◆ Depot injections
◆ Electroconvulsive therapy
69
What is the `mechanism of action` of **antipsychotics**?
Blockage of dopamine D2 receptors.
70
What are the `side-effects` of **schizophrenia**?
- Weight gain;
- Dystonia;
- Dyskinesia (long term);
- Drug-induced parkisonism;
- Neuroleptic malignant syndrome.
71
Describe what is:
- **Schizoaffective disorder**
- **Schizophreniform disorder**?
**Schizoaffective disorder**
- Schizofrenia
- Depression or bipolar disorder
**Schizophreniform disorder**
- Symptoms of schizophrenia lasting 1-6 months.
72
# Psych
What is the `Rx` for **rumination syndrome**?
Diaphragmatic breathing.
73
What are the `features` of **autism**?
- Severe difficulties in forming relationships;
- Language difficulties (understanding and expressing it);
- Repetitive and obsessive patterns of behaviour.
74
What is the `management` of **autism**?
- Behavioral and developmental programmes;
- Speech and language therapy.
75
What are the `features` of **ADHD**?
**➔ Symptoms present in ≥ 2 settings (home & school);**
**➔ For > 6 months before 12 years of age;**
- Hyperactivity;
- Impulsivity;
- Inattention;
- Excessive talking;
- Easily distracted.
76
What is the `management` of **ADHD**?
**Children**
- `Methylphenidate`
- Atimoxetine
- Focused group parents-training programme
**Adults**
- `Methylphenidate`
- CBT
77
What is the `management` of **acute psychosis** in a **`schizophrenic patient`**?
- IM haloperidol
- IM lorazepam
78
What is the `management` of **acute psychosis** in a patient with:
- **Parkison's disease**
- **Lewy body dementia**?
IM lorazepam.
## Footnote
Haloperidol is contraindicated, it blocks dopamine receptors in parkison worsening the condition.
79
Describe what is **incongruent affect**.
A schizophrenic man is seen laughing and smiling about his father's death whom he loved.
80
Describe what is **clang association**.
A schizophrenic man that speaks in rhymes.
81
What is the **management** of `phobias`?
Gradual exposure to reduce fear response.
82
# **`Antipsychotic side effects`**
**DDx between:**
- Tardive dyskinesia
- Akathisia
- Neuroleptic malignant syndrome
**Tardive dyskinesia**
- Repetitive ticking the tongue out;
- Repetitive lip smacking;
- Repetitive chewing
**Akathisia**
- Pacing around the room
- Feeling restless
- Needs to move legs
**Neuroleptic malignant syndrome**
- Hyperthermia
- Muscle rigidity
83
Which **antipsychotics** cause `galactorrhoea`?
- Risperidone
- Olanzapine
| Due to ⬆︎ levels of prolactin.
84
Which **antipsychotics** cause `gestational diabetes` and `weight gain`?
- Olanzapine
- Clozapine
85
Which **antipsychotics** cause `osteoporosis`?
Risperidone.
| Due to ⬆︎ levels of prolactin.
86
**DDx between:**
- Borderline personality disorder
- Antisocial personality disorder
**Borderline personality disorder**
- Unstable personal relationships
- Mood swings
- Marked impulsivity
- Self-harm
- Dramatic and attention seeking
**Antisocial personality disorder**
- Criminal acts
- Impulsiveness
- Aggresiveness
- Reckeless and consistent irresposability
- Lack of remorse
87
**DDx between:**
- Acute stress reaction
- PTSD
**Acute stress reaction**
- Symptoms start minutes to hours after the initial event and lasts up to 4 weeks;
**PTSD**
- Lasts for more than 4 weeks.
88
**DDx between:**
- Abnormal grief reaction
- Adjustement disorder
**Abnormal grief reaction**
- Recent loss of someone close
- Symptoms > 6 months
**Adjustement disorder**
- Recent loss of someone close
- Occurs within 1 month
- Cannot last more than 6 months
89
**DDx between:**
- Dissociative amnesia
- Dissociative identity disorder
- Depersonalisation / Derealisation disorder
**Dissociative amnesia**
- After a traumatic event
- Memory loss / forgetfulness
**Dissociative identity disorder**
- Multiple personality disorder
**Depersonalisation / Derealisation disorder**
- Out of body experiences
- Watching oneself from outside of their own body
- Feeling of surrounding's not being real
90
What is the `management` of **insomnia**?
`➔` `Sleep hygiene`
➔ **Sleep hygiene failure + insomnia due to short term stressor**
- Zoplicone
- Zolpidem
➔ **Sleep hygiene failure + insomnia unlikely to resolve soon**
- CBT
➔ **Insomnia + Learning disability (ADHD)**
- Sleep hygiene
- Melatonin
